May 1998

Introduction Background Definitions Preventability of Hospital Acquired Infections Hospital Acquired Infection - History and HAI Rates Distribution of HAI Risk Factors for HAI Comparisons of HAI Rates Cost Impact of HAI Nosocomial Pathogens Infections in ICU Surgical Site Infections Outside of ICU Trends in micro-organisms and resistance patterns Infection Control and Surveillance Programs (ICSP) Effectiveness of ICSPs and Preventability of HAI Effectiveness of Infection Control Practices Best Practice in Infection Control Programs General Overview Guidelines and Standards Policy and Procedure Manuals Approaches to Minimisation of Preventable Hospital Acquired Infection Leadership Guidelines and Standards Education and Training Enhancing Education and Training for Behavioural change Handwashing and Behavioural Change Other Strategies Antibiotic Resistance in Hospitals Emerging Patterns of Antibiotic Resistance Excessive and Inappropriate Use of Antibiotics Strategies to Improve Antibiotic Use Strategies to Control Antibiotic Use Impact of Controls on Resistance Patterns Other Important Strategies Dissemination of Resistant Strains Resourcing of ICSPs Staffing of Infection Control Teams The Physical Environment of Hospitals and Hospital Cleanliness Surveillance in Infection Control Programs Validation of Surveillance Purposes of Surveillance Techniques of Surveillance Best Practice in Surveillance Infection Rates for Measurement Data Reliability Use of Standard Definitions Use of Standard Surveillance Methodologies for Case Finding Adjusting Infection Rates Adjusting Rates for Length of Stay and Exposure to Devices Adjusting Rates for Severity of Illness Limitations of Small SampleSizes Computers and Surveillance Data Feedback and Confidentiality Existing Surveillance Systems Summary Surveillance and Quality of Care General Quality Indicators Collaboration and Quality Improvement Summary Cleaning, Disinfection and Sterilisation in Hospitals Best Practice in CD&S AS 4187 - Implications for Hospital CD&S Flash Sterilisation Disinfection and Sterilisation of Flexible Endoscopes Quality Control in Sterilising Facilities Role of CSSDs Implementation of AS 4187 Regional Services for CD&S Isolation Precautions Transmission Based Isolation Precautions Isolation Rooms Droplet and Contact Precautions Contact Precautions for Vancomycin Resistant Enterococci Airborne Precautions References Appendix 1 - List Of Abbreviations Appendix 2 - Glossary Appendix 3 - Useful Resources Best Practice in ICSPs HICPAC/CDC Guidelines Other Guidelines Major Publications - Textbooks Other CDC Documents Quality Standards Appropriate Use of Antibiotics Cleaning, Disinfection, Sterilisation Hospital Design Appendix 4 - Internet and E-Mail Addresses